Belgium legalises euthanasia for children of any age

Belgium today legalised euthanasia for children of any age, the first country in the world to do so.

The move has the broad backing of political parties and the majority of the public. The law still needs to be approved by Belgian’s head of state, King Philippe, but that is seen as a formality.

Belgium legalised euthanasia for over-18s in 2002. It is also permitted for adults in Luxembourg, and children of 12 and above in the Netherlands. A few US states, and Switzerland, have legalised assisted suicide.

In the UK, euthanasia and assisted suicide remain illegal, although there have been various attempts in the past few years to change the law so that those who help people commit suicide do not have to worry about prosecution.

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The new Belgian law applying to children includes certain safeguards&colon; two doctors and a psychiatrist will vet each case, and the parents have to agree too. The law also stipulates that the child must be able to decide for themselves, but sets no minimum age.

However, only a handful of terminally ill children a year are likely to choose to die, says Luc Deliens, chair of the end-of-life care research group at the Free University of Brussels and Ghent University.

No euthanasia explosion

“There will be no explosion of euthanasia cases,” he says. “There will be a very low number compared with the number of requests in adults.” About 2 per cent of all adult deaths in Belgium now occur through euthanasia.

Deliens says surveys show terminally ill children avoid asking for euthanasia because they think it would upset their parents. “Children don’t ask for euthanasia because they protect their parents. We know teenage children who have been living in hospital for months and months become very mature in a very short time,” he says.

When are children mature enough to make such a difficult decision? Neuroscience is of limited help in providing an answer. Previous studies show that the prefrontal cortex – an area involved in decision-making and understanding the consequences of your actions – is the last part of the brain to fully mature anatomically and functionally.

A functional MRI study in 2010 by Nico Dosenbach’s team at Washington University in St Louis, Missouri, suggests that major changes to structures in this brain region don’t level off until around the age of 20.

However, it’s not yet clear how such changes in the brain tally with a person’s behaviour. So it probably won’t help parents who are forced to make the heartbreaking decision of whether to agree to a child’s wish to die.

Free to decide

There is some research on how children themselves view euthanasia. Take Femke, a fictional 14-year-old girl who has terminal bone cancer, cannot tolerate the pain and wants to die.

Her hypothetical case was presented to 1769 Belgian teenagers aged around 14 at 20 secondary schools. Of these, 61 per cent said Femke should be offered euthanasia, compared with only 18 per cent for Nathalie, a girl with severe but not life-threatening burns.

In another study, 90 per cent of adolescent cancer survivors interviewed said terminally ill children should be free to make end-of-life decisions.

“Most children say they would want to make the decision on their own,” says Johan Bilsen of the end-of-life care research group at the Free University of Brussels and Ghent University, who co-authored both studies, “but would want their parents involved.”